Abstract #4

by | Sep 19, 2022 | 2022 Abstracts

Abstract 4- 0945-1000
Category: Clinical

At the end of the session,
participants will be able to:

  1.  To review the neuropathological findings in autopsy cases of multifocal necrotizing leukoencephalopathy (MNL).
  2. To understand the clinical scenarios that might be associated with development of MNL.
  3. To appreciate the growing spectrum of neuropathological findings in CoVID-19 central nervous system involvement,
    particularly in cases of severe disease.

COI Disclosure:

None to disclose

Presenter

I am a first-year resident in Neuropathology at the London Health Sciences Centre of London, Ontario, Canada. Prior to residency, I completed my medical school training in London as well at the Schulich School of Medicine and Dentistry. My research interests within the domain of neuropathology are focused on, but not limited to, forensic neuropathological diagnosis and pathogenesis of neurodegenerative disease.

Authors

Jacob A. Houpt 1, Lee Cyn Ang 1,2, Qi Zhang 1,2

1 Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada

2 Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada

Target Audience:
Pathologists, Residents, Medical Students, Other – Write In (Required): Anyone with interest

CanMEDS:
Medical Expert (the integrating role), Communicator, Collaborator, Health Advocate, Scholar

Multifocal necrotizing leukoencephalopathy post-CoVID-19 infection: expanding the “neuro-CoVID” spectrum

Abstract

Multifocal necrotizing leukoencephalopathy (MNL), also known as disseminated necrotizing leukoencephalopathy (DNL),  is a rare pathological phenomenon defined by numerous discrete foci of necrosis with predilection for ventral pontine white matter. While exact etiology and pathogenic mechanisms have yet to be elucidated, MNL is most often reported on post-mortem examination in the context of immunocompromised (ex: receiving chemotherapy or with untreated HIV-AIDS) or critically ill patients (ex: metastatic cancer, sepsis). Coronavirus disease 2019 (CoVID-19) is a viral respiratory illness with variable severity depending on host immune response and comorbid conditions. In its most serious cases, CoVID-19 can elicit both harmfully insufficient and excessive immune responses. We report on a case of CoVID-19 pneumonia which progressed to a clinical impression of sepsis, declining respiratory status, and death in an unvaccinated, previously well patient in which there were findings consistent with MNL throughout the midbrain and basis pontis. There was no encephalitis, microthrombi, infarcts, or other previously reported neuropathological findings. This index case was again compared and contrasted against four additional MNL cases examined at the London Health Sciences Centre. The neuropathological findings are examined and described for these 5 cases, all with clinical scenarios involving systemic critical illness and/or immune system compromise and with similar ventral pontine focal necrosis, myelin loss, and limited reactive glial response. Though numerous radiological studies have suggested a disseminated necrotizing leukoencephalopathic process underlying CoVID-19-associated encephalopathy, this case represents the first to offer pathological correlation supported by autopsy confirmation of MNL in a patient with CoVID-19 infection.